Difficult Conversations about Death and Dying

Julie McFadden (2s):
I’m not trying to be like pushy. I think people also think I’m going to try to be like pushy about like doing something and really it’s like, no, no, no. I just want you to understand what’s happening and how we can help your mom. And I think knowledge really helps decrease fear. At the end of the day. You don’t want your mom to be suffering and neither do we. And if that’s what you want, you are in the right place. And I’m glad I’m here because here’s how we can help with that.

Announcer (33s):
Welcome to Difficult Conversations: Lessons I Learned as an ICU Physician with Dr. Anthony Orsini. Dr. Orsini is a practising physician and President and CEO of The Orsini Way. As a frequent keynote speaker and author. Dr. Orsini has been training healthcare professionals and business leaders how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better This is the podcast for you.

Liz Poret-Christ (1m 19s):
Welcome to another episode of Difficult Conversations Lessons I learned as an ICU Physician, as you’ve probably guessed, this is not Anthony Orsini. We may recognize my voice from other episodes my name is Liz Poret Christ and I’m the managing director of the Orsini way. And I’ve been behind the scenes on every podcast episode, since we started. Don’t worry, Dr. Orsini will join me on the show, but I really wanted to introduce today’s guest. Today we’re honored to welcome Julie McFadden or otherwise known as Hospice nurse, Julie, as she’s known on social media. She has almost a million viewers between TikTok and Instagram and her warm and insightful ability to normalize and explain the death and dying process has made her a cultural icon.

Liz Poret-Christ (2m 3s):
Julie has been a nurse for 15 years, 10 in the ICU and 5 taking care of hospice patients. Julie’s gift to the world has been sharing her experiences, working in Hospice care and discussing topics like death in order to help others understand the process and alleviate the anxieties they may have about it. She is funny, honest, and a natural storyteller. Her incredible following has helped open up the conversations about death and dying and change the way people view hospice care. Julie has been featured all over the media in publications like the New York Post, Newsweek, USA today, and very recently interviewed on the End Well project.

Liz Poret-Christ (2m 44s):
Julie. We’re so excited to have you join us.

Julie McFadden (2m 48s):
Wow. Liz I’m blushing. You’re so sweet. A cultural icon. My God.

Dr. Anthony Orsini (2m 56s):
That’s why I keep her around. She’s good for the ego, right?

Julie McFadden (2m 59s):
Yeah. She’s stroking my ego this morning. Oh my gosh. Thanks for having me

Liz Poret-Christ (3m 5s):
Obviously conversations around death and the Dying process fall into the Difficult Conversations category. We’ve had other amazing guests like BJ Miller on the show to talk about how we can demystify death, allowing people to actively participate in the ways they leave this world. We often ask our guests to tell us a little bit about themselves so our audience can get to know you better.

Julie McFadden (3m 27s):
Yeah. So I mean, I’m Julie otherwise known as Hospice nurse Julie, which is so funny to me to like refer to myself as that. I grew up in Pennsylvania in the country, definitely a country girl at heart. I live in Los Angeles now, but I also love Los Angeles daily sunshine is key for me. How I got into nursing. I didn’t grow up at all thinking about healthcare or nursing. I don’t know what I was thinking about, but I think I just had other things on my mind, but I always loved learning about people and how to talk with people and connecting with people. So my first degree is in psychology and I thought I was gonna go down that scope and maybe become a therapist or something.

Julie McFadden (4m 7s):
And after I graduated, I was working in a hospital on a mental health unit and a woman had a seizure right in front of me and fell and hit her head and was bleeding profusely right in front of me. And I freaked out. I did not help. I ran away and ran and got the nurses. I knew enough to do that. Anyway, I was shaking. They said, I looked like a ghost. I was just, I couldn’t even tell them what happened. I was just going like, and they knew something was wrong. So they left me, they sat me down and they went to her and thankfully she was fine. She ended up, oh, not fine.

Julie McFadden (4m 47s):
I mean, she ended up going on a medical floor and I visited her the next day. I can remember her head was shaved. There were staples in her head. And I just remember that was profound to me that these nurses saw me and then ran to the problem that I was running away from. And instead of being like, I never wanna do that again. I was like, how do I become that person that was running to this person bleeding and knows how to help and isn’t freaking out. So that’s what started me on my nursing journey. And I already had a degree in psychology and the school I went to for my psychology degree had a accelerated nursing program where you could get your BSN, your bachelor’s degree in nursing in three semesters.

Julie McFadden (5m 30s):
So it’s a lot of work. And I had to do a bunch of pre-reqs and things like that, but I sort of fast tracked my way into getting a nursing degree. And I became obsessed. Like I loved nursing school, even though it was really hard. I loved it. I was like, holy crap. I didn’t know. I loved biology. I didn’t know. I loved chemistry. I didn’t know. I loved physiology. Like I loved it. I literally Googled after nursing school, number one hospital in the country. And cuz I was like, that’s where I’m gonna work. Talk about ego. I was like, and I’m gonna be an ICU nurse there and that’s what I’m gonna do. And then I’m gonna go back to school. I wanted to work in anesthesia eventually or so I thought, yeah. So I just did that. And then I applied for ICU nursing job there and I got it.

Julie McFadden (6m 12s):
So I moved to Baltimore, Maryland. Oh. To work at Johns Hopkins. That was the number one. I don’t know if they’re still number one, but they were, I don’t know. And it was amazing. I mean, I was very overwhelmed by my first nursing job. I remember that like for six months I dreamt of nursing every single night I dreamt of like beeps and scary things and it was just a lot, but I learned so much. That was my first, I’d say six years of nursing and surgical ICU there. And man, it was amazing. But that really got me passionate about doing healthcare a different way, doing end of life a different way.

Julie McFadden (6m 52s):
The more confident I became as a nurse there. And I also did this thing. I mean, this is kinda getting detailed, but just so you know how I moved around, they’re such a big hospital that they had a thing called intra staff where you could be a nurse for their intra staff and then you could move around the hospital. So I worked in medical ICU, trauma, ICU, surgical ICU. So I was doing different like ICU places in the hospital. And the more confident I got there, the more I realized, man, we’re really missing a link to talking about big goals, big life goals about what’s going to happen with certain patients. Not every patient’s gonna die in the ICU, But there were certain patients that were there for months and months and months.

Julie McFadden (7m 34s):
And we were really lacking the ability to talk big picture with the family about what was really happening to patients in general. I don’t mean every single person, every single patient, but in general. And then I started speaking up cuz I was confident enough at the time cuz now I’ve been a nurse for let’s say six years or something. And then I realized my voice really mattered. I would say one little thing like during rounds, should we talk about goals of care? What’s actually has to happen for this person to get out of the ICU. And I realized just that one little thing opened up the door to, well, let’s have a family meeting because we all know they’re not getting out of the ICU. We know healthcare workers, we know, but we’re not telling anybody.

Julie McFadden (8m 15s):
And they started making an impact. So that got me into like, wow, I, my voice actually matters, this is making an impact. And the impact was the people who ended up being taken off machines and dying. But I felt like that was actually better that they were actually hearing the truth versus this person and the family struggling day after day in this ICU focusing on small little things like the creatine going up or down instead of like this big picture of what was really happening to their loved one.

Dr. Anthony Orsini (8m 45s):
Julie that’s you don’t mind me interrupting. That’s a good point. Like I noticed as a neonatologist, what is your theory? Because I noticed that many times it is a nurse that will ask what’s our goal of care. Right? Let’s look at the big picture. And from my observation, it’s not that the doctor is against that. It’s that in many, instances it is that we get caught up in the weeds and it doesn’t even occur to us until the nurse goes, I think we should have a family meeting. And then the doctor in most cases there’s difference. I was like, wow, that’s actually a good idea. Is that your experience that they just didn’t occur to them?

Julie McFadden (9m 21s):
Yes, yes, yes. Yes. I don’t think anyone has like malicious intent. I feel like all of, I mean, I was guilty of that too. For many years. Took me six years to start being like, wait, what are we doing? Why aren’t we having conversations with the family? Not just with each other, cuz we would talk kind of candidly with each other a lot. And neither one of us would think to bring it up. That’s the point is once I did, everyone was like, oh yeah. And I think it’s just because we’re all so focused on the little wins, the little wins we have, but those don’t always add up to a person getting out of the ICU or going home or being well. Right. So yeah. I found that the second I brought it up, it was like, oh yeah, duh.

Julie McFadden (10m 2s):
Then we had family meetings and things were changed and things happened. Meaning that family was like, okay wow. Now that I know this, I don’t want them to be like this forever. They usually ended up taking people off ventilators and them passing peaceful in the ICU. But so yeah, that made me realize I had a voice and it just got me into end of life care. And then I eventually transitioned into Hospice.

Liz Poret-Christ (10m 25s):
Would you say that there was one defining case that made you say, okay, there’s just gotta be a better way than this. I’ve got to switch gears.

Julie McFadden (10m 32s):
Yeah. There’s two people. I remember specifically that got me into having those end of life conversations. I was taking care of them day in, day out. And I saw them when they first came here. When they first got into the ICU where they were still possibly well enough to leave how the ICU works, certain things happen. They have a PE they have whatever then. So I was taking care of them for months. And those two patients, I feel like I had the biggest impact because I was the one to say, we need to have a family meeting about what the end goals are for this person and for their family. And seeing that unfold into a really making changes in their plan of care is what made me go, okay, this is what I wanna do. I don’t wanna be an ICU nurse.

Julie McFadden (11m 14s):
I wanna do whatever this is. I didn’t know what that was. But I thought, well, Hospice seems kind of like that. Oh, I’m gonna try that.

Liz Poret-Christ (11m 23s):
So people often confuse palliative care and Hospice care. And even though a lot of our audience or healthcare providers, can you shed a little bit of light on what the difference is between the two?

Julie McFadden (11m 33s):
Yeah, I think it’s difficult to explain. So to me, what I’ve witnessed is palliative care seems to be different and different facilities depending on where you’re at. But in general, I would describe palliative care as a symptom management program where they help more with, there’s definitely something, a big terminal or chronic disease going on and they need help managing the symptoms of the disease or the symptoms of the treatment for the disease. So it’s more of a symptom management team where we’re helping keep them out of the ER. So we manage their symptoms so they can have a smoother ride and not need to use urgent cares and ERs for their symptoms. That’s how I would describe palliative care.

Julie McFadden (12m 14s):
And then Hospice is first off funded by Medicare. So it’s very federally regulated and it’s usually less than six months. You’re comfort focused only. You want to be at home. You’re not going back and forth to the ER. You’re not getting treatments. It’s very comfort focused versus palliative is the same way, but it’s more symptom management focused and you can still get treatment. You can still go in and out of the ER, if you wanted to. That’s how I describe it.

Liz Poret-Christ (12m 39s):
Would you say it was difficult to transition from the ICU setting where you’re trying to fix everything and make everything better to just coming to terms, discussing with families and patients that Hospice care here we are, we were trying to make you comfortable. Nothing’s really gonna change or fix anything. Is that a difficult kind of transition to make in your own head?

Julie McFadden (13m 1s):
Well, girl, I was ready. I was ready. I was like so relieved and happy to see how we were doing it in Hospice, which was much more comfort focused and being really aggressive with comfort care, which I love, but it was a shift just cuz I was a nice uni nurse for so long. I was like, what’s their potassium? Shouldn’t we check this, you know? And they were like, whoa, whoa, whoa, whoa, chill out girl. We don’t need to do any of that now. I mean, it was hard for my brain to shift, but once I started catching on it was like, oh my gosh, this is amazing. And to watch the human body take care of itself, without us doing much intervention was amazing. That’s the biggest thing I learned and witnessed and why I became so passionate about it was like, wow, we’re barely doing anything.

Julie McFadden (13m 46s):
And the body is like taking care of itself.

Dr. Anthony Orsini (13m 49s):
Yeah. That’s an amazing thing.

Liz Poret-Christ (13m 51s):
It’s a perfect transition to my next question. So your social media, and we’re gonna talk in a second about how you got on social media and why that occurred to you, but your topics on your TikTok and your Instagrams, The Rally, Death with dignity, Myths about morphine. Like those are all so helpful to people that don’t understand. How did these come to you? Is it intentional or does something happen? And you’re like, I need to let people know about that.

Julie McFadden (14m 17s):
Yeah. Well, I mean, I’ve been a Hospice nurse for five years, so I’ve had five years of experience with in real life. Right. And the things I talk about on TikTok are the things that I run into a lot in real life as a Hospice nurse. So that’s how that came to me. I just knew there was so much information that most people in the general public did not know. And I thought it was crazy. I thought people need to know. It seems like also in real life that most people don’t want to know or don’t want to hear me talk about it. So I was kind of like, I wonder how this is gonna go as far as the social media thing, because I didn’t know if people were gonna want to really hear about it.

Liz Poret-Christ (14m 56s):
I think your number of followers suggests otherwise.

Julie McFadden (15m 0s):
I know it’s really validating. It was very surprising, but Hey, I love it. I love it.

Liz Poret-Christ (15m 5s):
Tell me how that happened. How did you say, you know what TikTok is gonna be my platform. That’s where I’m going.

Julie McFadden (15m 11s):
Well, I was initially going to do a podcast, but then I realized that’s a lot of work and a lot of editing and I just didn’t know what yes. Right. I just didn’t know what I was doing. TikTok was never on my radar ever. I mean, I I’m 39. I was not on TikTok. I’d barely heard of it, but I went home to see my nieces and my nieces are 11 and 12 and they were on TikTok and they were doing dances and trying to get me to do it with them. And I was kind of teasing them and making fun of ’em how silly this was and whatever. Right. And I got on TikTok to basically watch their TikTok because they were doing cute dances and they’re my nieces. And I started watching TikTok and I was like, oh my gosh, this is amazing.

Julie McFadden (15m 51s):
There were so many people on there talking about all types of things. This is amazing. I love it. So I just made a few videos and put ’em out. And I think it took like a couple days within a couple days I had like multiple viral videos. So I was like, well, I guess I’m gonna do this. It really did feel like there was no hustle. It was like, It just sort of fell into my lap.

Dr. Anthony Orsini (16m 14s):
Julie, I have a question that since it topics Difficult Conversations and you had these TikTok that are having Liz said, they’re really great pieces on things that people want hear about. Most of the time when people refer to a Hospice nurse, if they’ve any interaction with a Hospice nurse in their life, do you hear the word angel? They’re wonderful. They’re forget. We’ve had some experience with my grandparents, But there are in my experience, unfortunately we, I do a lot of death of dying too. There are different views on that. And so walk us through when you I’m sure this has happened before you go into a house, you’re doing your Hospice.

Dr. Anthony Orsini (16m 53s):
You have one son who’s really grateful to have you there. And then you have the other reluctant son who just agreed to this because he was being pushed into it and looks at you in that way. Like, I don’t want you here because you being here means my mother’s gonna die. And I’m sure that’s common in how you navigate through that. That’s gotta be difficult.

Julie McFadden (17m 18s):
I have gotten to the point now though, where what’s really cool with my job specifically, which I know most people don’t have. This is, I have like a lot of time I could really spend like hours in a home because I have nothing else to do that day. Almost. There’s a few things, but like in general, I’m like dedicated to this family. So now that I’ve been doing it for a bunch of years, it is difficult, but I enjoy it because I think you have to be really good. And I don’t know. And you guys can tell me cuz you, you do this for a living as well. If this could be taught or not. I think you’re saying, saying it can be taught because I feel like I am pretty good at reading the room and reading people’s personalities, cuz I’m not trying to convince anyone of anything, but people lack education about the d,ying process and about death in general.

Julie McFadden (18m 5s):
So what I usually try to do is just meet people where they’re at. I’m not trying to be like pushy. I think people also think I’m going to try to be like pushy about like doing something and really it’s like, no, no, no. I just want you to understand what’s happening and how we can help your mom. And I think knowledge really helps decrease fear at the end of the day, you don’t want your mom to be suffering and neither do we. And if that’s what you want, you are in the right place. And I’m glad I’m here because here’s how we can help with that. And the idea of like, what do you mean you’re not going to feed her? What do you mean? We’re not gonna give her IV hydration when she can’t eat.

Julie McFadden (18m 47s):
They’re saying that cuz they think they’re going to suffer because they’re not getting IV hydration. And that’s the opposite. The opposite is actually you’re gonna feel better not getting IV hydration. And so usually I met with resistance until they really hear and learn. And then they’re really grateful. Usually, not always. And if it’s not like that and they still are really resistant, they don’t wanna listen or they walk out of the room. You know what? That’s okay too. That’s okay too. It’s very normal. That’s another thing too. Is I normalize what’s happening. It’s so normal for you to have all types of emotions, negative anger, sadness, you know it’s okay too. And guess what? We’re here day in and day out.

Julie McFadden (19m 28s):
So we’ll keep coming to help your mom. And as time goes on, if you are wanting to talk or have any questions, we’re here for you, it can be difficult and it’s not always easy, but I do find that education and time seems to really help.

Dr. Anthony Orsini (19m 43s):
It’s all about communication. Yeah. So yeah. Thank you. I think that’s really important. And that’s what Liz and I teach so often is, you know, it’s about the why it’s about being a real person. It’s about being genuine. It’s about not judging people for understanding. I mean there’s people that have all irrational thoughts about that. Right? I know people who don’t wanna take out a life insurance policy because they think it’ll jinx them. If they take out a insurance policy, they’re gonna die.

Julie McFadden (20m 7s):
Healthcare workers do healthcare workers will say it’s up to me that I’m like, no, no, no, no. That’s not true anyway. Yeah. Yeah.

Liz Poret-Christ (20m 16s):
And I think some of that anger and frustration comes really from guilt. We always say, when we’re doing our trainings that the family members feel guilty for not doing what they think they should be doing. And that sometimes the more loving thing to do is to not do anything, anything. And that is really very eye-opening for them. It’s all about that permission to understand it in a different context. And I think that’s something you’ve done so well.

Dr. Anthony Orsini (20m 43s):
It’s funny cuz that’s the phrase that we teach a lot of times there’s certain things that when we’re teaching communication to doctors, there’s certain phrases that they grab their pen and they write that down. And So we say sometimes it is the more loving thing to do is to not do something and not like mom suffer. And Liz will tell you all of a pen comes out. Oh I love that. I’m write that down.

Julie McFadden (21m 5s):
One thing I say to when I can like, we, it in there is because it’s so natural for people’s brains to start going. We’re not doing like at first they’ll be agreeing with me while I’m there and then I leave and then their brain starts going, well, why are we doing this? I didn’t ask her this. You know, like starts the questions we need to do this. We need to do this. We’re not doing enough. I need to do do. So. I always say, when that starts happening, ask yourself, is she clean? Is she safe? Is she comfortable? And if those are yesses, we’re good. And just be with her that just clean, safe, comfortable. That’s what she wants. That’s what the goal is. And they’ll be like, okay. Cause I think sometimes you just, your brain needs something to chew on.

Julie McFadden (21m 46s):
So you can just ask yourself that clean, safe, comfortable.

Liz Poret-Christ (21m 49s):
What would you say? The question you get the most is

Julie McFadden (21m 54s):
Usually if they have a good grasp that their loved one is dying is when, how long do we have, when’s it gonna happen? And a lot of times I feel like we can give a range. Usually I always say like you never really know. And I definitely learned that the hard way, I was like way more confident on like when this was going to happen in my earlier days. So now I always just preface it with you never know. And I truly mean that like the body will tell us when it’s ready, but in general, the further people are away from death. I suppose it’s harder. But the closer someone gives you start seeing very clear signs. We do try to give a range, but that’s probably the main thing.

Julie McFadden (22m 33s):
If they’re really grasping, what’s happening, they’ll ask how long do we have?

Liz Poret-Christ (22m 38s):
So if you are like us, every time you go somewhere and tell somebody what you do, they’re gonna fill your head with stories of some experience that has happened to them. Would you say that everywhere Tony and I go, somebody will say I had this doctor once that said this and we get stories from the taxi cabs to the people on the line, in the restaurant, wherever does that happen to you as well?

Julie McFadden (23m 3s):
Yes, but I usually get like a, Ugh, I I’d say I’m a Hospice nurse. Cause I never mentioned the TikTok up unless someone said it to me, but yeah, I’ll like, oh I’m a Hospice nurse and they’ll either go, oh wow. Or like that must be depressing or that must be hard or, oh, you’re an angel every once in a while. They’ll talk about, I mean, if they’ve had the experience, but it’s usually just a reaction, like a yikes,

Dr. Anthony Orsini (23m 32s):
What’s the most fulfilling thing about your job.

Julie McFadden (23m 35s):
Truly people think my job is hard. Like to me it is the best nurse. And I tried a bunch of nursing jobs. I wasn’t just an ICU nurse. I had a whole spiel of like pre-op post-op PACU, cath lab stuff. Education, Hospice is not a thankless job. You can see the gratefulness in people. So the best part of my job is like, and not that I need that, but it’s really helpful. Like it, you see the impact you have with patients and families and they are grateful for the most part and it’s the best it makes my job totally worthwhile. It doesn’t make it depressing at all. Even when you have a very hard conversation about death and them dying, you still leave there feeling like, wow, that really helped them.

Julie McFadden (24m 20s):
They are telling me how much that helped. And it doesn’t feel sad. It feels like sacred. It’s amazing.

Dr. Anthony Orsini (24m 28s):
The title of the lecture and the workshop that we give is breaking bad news is called helping families where they need us the most. Yeah. And I truly believe that, you know, I joke with doctors, I could teach anybody how to put a chest tube in, put an IV in it. Doesn’t take a rocket scientist to do that, but to do Hospice and death and dying well and to help families when they need us the most, that is a skill that I think anybody can learn if they’re willing. And of course some people are better at it than others. But to me, that’s the most important part of my job. And I deal with little babies. And so, and boy, that’s hard to tell a mother that, you know, other, baby’s not gonna make it, but when you’re there, I tell everybody I got 15 years in a row.

Announcer (25m 13s):
Now I’m getting Christmas cards from a family. This patient died on baby, died on me.

Julie McFadden (25m 18s):
Wow.

Dr. Anthony Orsini (25m 18s):
I’m much more proud of that than any chest tube, lumbar puncture I even intubations I did. So it’s interesting.

Julie McFadden (25m 25s):
Yeah. I can really say I love my job. And like I always say I would do it for free. I mean, of course, if I had like millions of dollars, I still feel like I would do my job at least a couple days a week. I love it. And I did not love nursing. I did not love it. I actually like really thought, oh, I made the wrong choice. This is not the career for me. I was thinking about getting out of nursing. Right. And really I just needed to find the right fit.

Liz Poret-Christ (25m 50s):
Well, I think as a nurse, you’re trying to, you think you’re going to ease someone’s suffering. Yes. And that’s just always the case. And here you really are easing people suffering, both the families and the patients. So I think it’s such an amazing job that you have. Then if you could tell people one thing about Hospice, somebody that’s newly diagnosed is being terminally ill or whatnot and is being referred to Hospice and they’re so scared. What would be something that you would tell them? Or what does that first conversation look like?

Julie McFadden (26m 22s):
That first conversation, if they’re scared, cuz there’s several things I would say about Hospice, but I guess if it’s the first conversation and they’re scared, it would be that our bodies are built to survive birth for the most part and give birth. If we’re women and we decide to have a baby, our bodies do crazy things during the birthing process to have a baby. And what I have found from being a hospice nurse, just time and time again, watching people go through the death and dying process physically is that our bodies take care of ourselves. Like our bodies are built to die. And if you’re Dying, what I would call a natural death, even though it’s from a disease, our body will do things to really take care of us. You know, it’ll start sleeping more, it’ll start eating less and just listen to your body.

Julie McFadden (27m 7s):
And for the things that if you’re getting symptoms because of your disease process, we could help you with that. That’s why we’re here and we’re gonna help you with that. So you don’t suffer from pain or shortness of breath or whatever your disease is causing. But other than that, listen to your body because it will help. You have a peaceful transition, a peaceful end of life. We all have a end of life journey and your body is built to do it. So the more you listen to it, the better it’ll be. And it’s really normal to be afraid.

Dr. Anthony Orsini (27m 36s):
Love that.

Julie McFadden (27m 37s):
And it’s okay. It’s like people listen all the time. Like what do you say when someone says they’re afraid? I usually I’m, I’m a dependent. Like I said, I feel like I read the room. So I don’t just make a joke cuz that’s not funny. But I think people need to feel validated. Of course you feel afraid. This is the unknown you don’t know. And you’re gonna feel afraid. You’re gonna feel angry. You’re gonna feel peaceful. Like it’s gonna fluctuate and that’s okay. And you’re way ahead of everybody. If you’re able to talk about it, the fact that you can talk about it is like, man. Okay. I think it’s really great to show up for people and be the one person. Hopefully they have more, but at least one person who’s not afraid to listen to them. Say stuff like that.

Julie McFadden (28m 17s):
Cause most people will. No, no, no, no. It’s okay. It’s okay. It’s okay. It’s like, it’s not okay. It’s okay. You’re not okay. It’s okay to say the word dying to say you’re scared and just sit there and like acknowledge that and be okay with them being afraid. Does that make sense? You know what I mean? Like the one person who’s not trying to make them not feel that way. Of course you feel afraid.

Dr. Anthony Orsini (28m 38s):
One of the coolest things that I’ve ever seen is my father-in-law. He died at 96, I believe he was and he, God bless him. He was healthy. God bless him. But he had two wishes and one was to make sure he took care of my mother-in-law, that he out survived her cuz she needed some help. And the second wish was that he didn’t have to go to a nursing home. That was the two things that he wished in his life. He had a very difficult life. He lost two babies, depression kid, the whole deal, but always considered himself the luckiest person. And so the Hospice nurse was there towards the end and she called the children in. And boy, she was right on like, she’s like, I think he’s got three hours left and boom.

Announcer (29m 20s):
It was about three hours. But his last word, when he was just about dying, he looked up and he said to everybody goes, I won. And then he passed away and I’m like, is that a great story?

Julie McFadden (29m 35s):
Oh my God,

Dr. Anthony Orsini (29m 36s):
Isn’t that a wonderful story.

Julie McFadden (29m 37s):
Best thing ever heard?

Dr. Anthony Orsini (29m 39s):
And I’ve always respect him because this is a man who had really a tough life. He blesses. But there, when he was young, his father became an alcoholic. He lived in 16 homes in the Bronx when he was growing up, joined the Navy when he was only 17, just to have a stable life and gets married, loses two children has four healthy children by all purposes, he could have just said I had a rough life. And he said, every day I knew him. He’s like, I’m like this guy ever, is that a great quote? I won.

Julie McFadden (30m 7s):
That’s so good. I won. Oh man.

Liz Poret-Christ (30m 10s):
But that’s the goal of it all. Isn’t it. At the end of the day, what a blessed life to be able to say and what an amazing person he must have been to be able to say I won.

Dr. Anthony Orsini (30m 21s):
And sadly there’s too many people who don’t live until 96 and live really young. And that’s super sad. And I don’t mean to minimize that, but I just think it’s a great story on how he looked at that and how wonderful the Hospice nurse was. And even as a doctor, I’ve always been astonished how some of these Hospice nurses can pretty much tell you when the person’s gonna die. They have such experience. It’s amazing.

Julie McFadden (30m 45s):
Yeah.

Liz Poret-Christ (30m 45s):
So Julie, I sent you this question in advance, cuz we like to kind of give you a heads up.

Julie McFadden (30m 50s):
Thank you.

Liz Poret-Christ (30m 50s):
Is there a type of conversation or even a specific conversation that you find the most difficult? Obviously the name of our show, Difficult Conversations. So it can be a general topic of conversation. It could be something specific. And how did you navigate it?

Julie McFadden (31m 8s):
That’s so funny cuz there’s so many Difficult Conversations on Hospice, but they don’t feel that difficult. Like I kind of like it. Right. I kind of like the challenge. That’s a bad way to say it, but I think, you know what I mean? The ones that are really hardest on me anyway, like when I go home being like, Ugh, like that was a rough day is when sometimes there’s like nothing to do. Like sometimes like I can’t ease the suffering, we can do our best. Right. So like you said, someone’s young, they have a really crappy disease. They’re dying from usually when you’re dying young, it’s usually something, not that easy and there’s a lot of symptoms and we’re having a hard time managing it.

Julie McFadden (31m 50s):
We will get it managed, but it can take a few hours for things to kick in. And like those conversations of like someone being like, what’s wrong, I just don’t feel good. Like I can’t stop throwing up or I’m nauseous, da, da, da, and the family members there being like, how can we help them? And you’re doing all these things like that conversation is sometimes like is just hard. All I can say is like, it’s just hard.

Dr. Anthony Orsini (32m 13s):
What do you say, Julie, when that happens? Or like we say, I can’t help

Julie McFadden (32m 17s):
Again. It’s kind of different for everybody, but I try to be really with them in that moment and just sort of help them understand that like this is how it goes sometimes. Cause the family will be like, why is this happening? Why is she feeling this way? Why? Or like terminal agitation or something where they’re like, they won’t stop getting out of bed. Cause they just seem very agitated. And I just try to explain to them, there’s not always a specific answer. We don’t always have the answer. This is just what happens sometimes at the end of life. And here’s when I see it with young people, I see it with this type of disease and here’s what we do for it. And if that doesn’t work, we’ll do this in those moments.

Julie McFadden (32m 59s):
I think they need a little bit of a timeline, a little bit of like, we just need something to grasp onto because we are losing it. And so I do, I try to give them like, this is the solution that, that doesn’t work will do this. And then in general, just sort of sitting there with them in the grief of this is really hard. Cause I think there, it’s not always hard. It is sort of like I won a bunch of, I won moments, But there are times. And it’s usually when they’re younger and with specific diseases that it’s just hard. And I try to sit there and not always have a solution. Sometimes I do sit there for a bit and just say, sometimes it’s just hard. You’re not losing your mind. This is just hard.

Dr. Anthony Orsini (33m 38s):
I would say when it’s a child, they say that’s the worst loss you could imagine. Especially when it’s someone’s child is passing.

Julie McFadden (33m 44s):
I don’t actually don’t do children. I’ve never experienced that.

Dr. Anthony Orsini (33m 48s):
It’s a pain. I can’t even imagine it’s

Julie McFadden (33m 50s):
Yeah. I would have to do your guys’ classes. Cause I wouldn’t. That is something I feel like I don’t, I don’t know. And I’m not a mother either. Right. So it’s like, I really don’t know.

Liz Poret-Christ (33m 59s):
So is that purposeful? Do you just, do you specifically choose not to do pediatric or is that a,

Julie McFadden (34m 6s):
I think I would, I guess if our company did it, but I would really feel like I need help. I would need, I probably would just treat it like I’d do anything else, but I I’m sure. I feel like I would be ill-equipped for that. Be a learning curve for sure. I’d want some help from someone.

Liz Poret-Christ (34m 22s):
So what’s the process. How does somebody access you? Should they need you, should they want to know more? How does somebody find you?

Julie McFadden (34m 30s):
Well, I’m on all social media platforms at Hospice nurse, Julie across the board. I’m mainly on TikTok, TikTok and Instagram are my main like sources I guess. But yeah. Hospice nurse Julie on TikTok, Instagram, Facebook, YouTube.

Liz Poret-Christ (34m 44s):
Thank you so much, Julie, for joining us. If you don’t follow Hospice Nurse, Julie, I recommend that you to it right away. I have learned so much. Unfortunately I’ve had some tragic deaths in my family and I knew about The Rally. And when you talk about it in your post, I actually have a friend who didn’t know anything about it because most people don’t. And by when I say The Rally, Julie, probably explain it better. But as far as I understand is shortly before someone passes away, they have this miraculous or what seems like a miraculous momentary recovery where they can communicate. They might sit up, they might talk, they might get up.

Liz Poret-Christ (35m 27s):
And in the case of my friend that I had mentioned it to that mom, young mom was dying with young children and she was able to write all of her children letters before she passed away. And my girlfriend had said to me, I’m so glad that you told me about that because I would’ve never known and what a gift that was for her to be able to leave that for her children. So I feel like Julie, that’s what you’re doing about all of these things is you’re giving this very compassionate insider’s view into the things that people are afraid to talk about. And I’ve learned a lot and I’m so glad that we met you. And so glad that you came on the show.

Julie McFadden (36m 3s):
Thanks guys.

Dr. Anthony Orsini (36m 3s):
Thank you, Julie, and spent an honor for getting to know you and I’m sure we’ll keep in touch and it’ll be great.

Julie McFadden (36m 9s):
Thanks for all you guys are doing.

Dr. Anthony Orsini (36m 11s):
Thank you. If you enjoyed this podcast, please go ahead and hit follow on your favorite platform. We’re on every platform imaginable. You need to get in touch with Liz or I just get in touch with us at TheOrsiniway.com and we will put all of Julie’s connections on the show notes. And please go ahead and tell your friends it’s an important topic. So don’t hesitate to contact Julie, Liz, awesome Job.

Liz Poret-Christ (36m 37s):
Thank You. Thank you everybody.

Announcer (36m 39s):
If you enjoyed this podcast, please hit the subscribe button and leave a comment and review. To contact Dr. Orsini and his team, or to suggest guests for future podcast, Visit us at the Orsini Way.com. The comments and opinions of the interviewer and guests on this podcast are their own and do not necessarily reflect the opinions and beliefs of their present and past employers or institutions.